CASE SERIES ON RHABDOMYOLYSIS & AKI.pptx

Aki
Rhabdomyolysis

1. Trends and Outcomes of A cute K idney I njury in Rhabdomyolysis : A Case Series Author : Dr . Gnanshree Dave (2 nd yr PG , Dept.of General Medicine,PGI ,YCMH) Co-Author : Dr.Pravin Soni Sir ( Prof & HOD, Dept of General Medicine,PGI,YCMH )

2. ABSTRACT

3. Project analysis slide 4 Project Analysis INTRODUCTION TRAUMA NON TRAUMATIC CAUSES RHABDOMYOLYSIS PRESENTATION EARLY COMPLICATION ASYMPTOMATIC LATE COMPLICATION Lorem ipsum dolor sit amet. Lorem ipsum dolor sit amet. Early complications (< 12-72 hrs) Hypovolaemia Hyperkalaemia Hypocalcaemia Cardiac arrhythmias Cardiac arrest Late complications (> 12-72 hrs) Kidney damage ATN Acute renal failure DIC ARDS sepsis

4. PROSPECTUS Studies describing AKI risk factors and progression are very few The McMahon score is a validated scoring system to predict those at higher risk of requiring renal replacement therapy, with a score greater than 6 conferring a risk of renal replacement therapy of 52%. 5 In this study , we aim to characterize the incidence of AKI in patients with severe rhabdomyolysis, to identify clinically useful predictive factors of KDIGO stage 2–3 AKI, and to provide a special focus over the risk of AKI to CKD transition in these challenging settings

5. MATERIALS AND METHODS Retrospective O bservational D escriptive C ase S eries including 6 cases of Rhabdomyolysis admitted at YCMH between January 2023 to March 2024 with Inclusion criteria : all of the cases having minimum serum CPK levels more than 1000 U/L and Exclusion criteria : none of the patients had pre-existing end-stage renal disease or history of any cardiac or renal ailment.

6. PATIENT NO AGE SEX ETIOLOGY DAY OF FAD MANAGEMENT OUTCOME of AKI 1 30 M ALCOHOL WITHDRAWAL SEIZURE 4 HD- 3 sessions Resolved 2 78 F STATIN INDUCED MYOPATHY 3 HD- 7 sessions Resolved 3 32 M ALCOHOL BINGE 2 HD -13 sessions Resolved 4   40 M MODS PANCREATITIS SEPSIS ALCOHOL 4   HD - 2 sessions DEATH 5 56 F CRUSH INJURY RTA 5 HD- 8 sessions MAINTENANCE HD at 3 month follow up 6 40 M NEUROLEPTIC MALIGNANT SYNDROME 1 FAD & IV FLUIDS ONLY Resolved

7. DISCUSSION Rhabdomyolysis is a frequent, life-threatening condition that develops solely or in combination with an underlying acute condition. Large studies specifically dedicated to severe rhabdomyolysis are scarce, and thus there isn’t yet an accurate characterization of the predictive factors of severe AKI. In recent years, epidemiological studies clearly demonstrated a significant risk of progression from AKI to CKD after a single event of AKI [8]. Contrasting with data from older studies, our study shows that alcohol as a causative factor is more common than crush injury in our settings.

8. DISCUSSION The higher the CKNAC levels at presentation combined with delayed onset of initiation of fluids and diuresis , precipitate higher risk of developing AKI that would have greater probability to progress to CKD. This idea is in agreement with animal studies that have demonstrated that single episode of rhabdomyolysis-induced AKI was actually followed by progression to interstitial fibrosis and CKD [9]. More than 50% cases land up in acute kidney injury and out of those almost 40 % require RRT of which 10 % require continuous RRT in future as well

9. INCIDENCE RATES OF ETIOLOGY

10. VARIOUS OUTCOMES & THEIR PROBABILITY

11. CONCLUSION Severe rhabdomyolysis leads to AKI in almost half the patients admitted to an ICU and requires RRT in a third of the cases. The long-term renal outcome appears to be strongly correlated to serum CKNAC levels at admission and its progress on the onset of initiation of aggressive fluid and diuresis therapy. Future prospective studies with intervention are suggested for other parameters of MacMohan score to determine risk of AKI to CKD progression

12. REFERENCES Baeza -Trinidad R, Brea-Hernando A, Morera -Rodriguez S, Brito-Diaz Y, Sanchez-Hernandez S, El Bikri L, et al. Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis. Intern Med J. 2015;45:1173–8 Rodríguez E, Soler MJ, Rap O, Barrios C, Orfla MA, Pascual J. Risk factors for acute kidney injury in severe rhabdomyolysis. PLoS ONE. 2013;8:e82992. Chavez LO, Leon M, Einav S, Varon J. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Crit Care. 2016;20:135 Simpson JP, Taylor A, Sudhan N, Menon DK, Lavinio A. Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: a retrospective observational evaluation. Eur J Anaesthesiol . 2016;33:906–12. McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med. 2013;173:1821–8 Candela N, Silva S, Silva S, et al. Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients. Ann Intensive Care 2020; 10(1): 27. DOI: 10.1186/s13613-020- 0645-1 Petejova N, and Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Crit Care 2014; 18(3): 224. DOI: 10.1186/cc13897

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